Intramedullary sarcoidosis presenting as incomplete paraplegia: case report and literature review.

Sarcoidosis is a chronic, multisystem noncaseating granulomatous disease of unknown etiology. Sarcoidosis typically presents clinically in individuals between the ages of 20 and 40 years. Although sarcoidosis most commonly affects the respiratory system, nearly any organ system can be involved. Spinal cord involvement by sarcoidosis is a rare event, occurring in less than 1% of patients with systemic disease. The case presented is that of a 29-year-old black male with benign past medical history who presented with a 6-week history of progressive incomplete paraplegia and bowel dysfunction. Magnetic resonance imaging revealed an intramedullary mass at the T-4-T-5 levels. The patient underwent thoracic laminectomy and debulking of the mass. The pathology was consistent with granulomatous disease. Postoperatively, the patient was placed on prednisone. He subsequently received comprehensive inpatient and outpatient rehabilitation and at present is bowel and bladder continent and ambulating at community levels with a rolling walker. The diagnosis of sarcoidosis; potential treatment options, including debulking and long-term steroid use; and prognosis will be discussed.

Latex allergy in adults with spinal cord injury: a pilot investigation.

Latex allergy is a well-known complication of repeated exposure to natural rubber latex (NRL) products. The medical literature is replete with studies investigating the prevalence of NRL allergy in myelodysplastic children. However, the prevalence of NRL allergy in adults with spinal cord injury (SCI) has received little attention. Patients with a history of NRL exposure secondary to long-term indwelling urinary catheter usage were recruited as subjects. The presence of NRL allergy was established using the radioallergosorbent assay technique (RAST). Serum from 15 subjects who had been injured an average of 23.8 +/- 11.9 years and who had used an indwelling urinary catheter an average of 17.1 +/- 11.5 years was obtained. RAST for NRL was positive in 7 of the 15 (47%). Of note, serum obtained in a control group of 4 subjects who had been injured an average of 54.4 +/- 3.1 years and had no significant history of long-term indwelling urinary catheter usage were all RAST negative. This study suggests that adults with SCI and significant NRL exposure via long-term indwelling urinary catheter usage may be at risk for the development of NRL allergy.

Midodrine hydrochloride and the treatment of orthostatic hypotension in tetraplegia: two cases and a review of the literature.

STUDY DESIGN: A report of two cases of orthostatic hypotension in acute tetraplegia that were resistant to classic treatment interventions. OBJECTIVE: To discuss the use of midodrine hydrochloride for the treatment of orthostatic hypotension in early tetraplegia. SETTING: Department of Rehabilitation Medicine, The University of Texas Health Science Center at San Antonio, Texas, USA. METHODS: Presentation of two cases. RESULTS: Midodrine hydrochloride successfully treated two cases of orthostatic hypotension that had been refractory to classic treatment interventions. CONCLUSION: Midodrine hydrochloride should be included in the armamentarium of the physician treating orthostatic hypotension in spinal cord injury.

Pilot evaluation of a nurse-administered carepath for successful colonoscopy for persons with spinal cord injury.

Due to ongoing improvements in medical care, the life expectancy of persons with spinal cord injury (SCI) continues to improve and approach that of the able-bodied population. As the SCI population ages, cancer would be expected to increase as a cause of death. When a patient presents with occult fecal blood and anemia, colonscopy to the cecum is often pursued. It has been our experience that 80 percent of patients are found to have inadequate bowel preps resulting in suboptimal colonoscopy when the prep is attempted at home. Because of this, we developed a nurse-administered carepath necessitating a 48-hour admission for bowel prep and colonoscopy. The bowel prep consists of magnesium citrate, polyethylene glycol-electrolyte solution, and sodium phosphate/biphosphate enemas. Throughout hospitalization, the patient receives a clear liquid diet. Eighteen patients have been placed on the carepath. At the time of colonoscopy, all 18 were noted to have received an acceptable bowel prep allowing vizualization to the cecum. A description of the carepath and its benefits is presented.

The treatment of immature heterotopic ossification in spinal cord injury with combination surgery, radiation therapy and NSAID.

Heterotopic ossification (HO) is a frequent complication associated with spinal cord injury. Management of HO consists of a combination of range-of-motion, diphosphonates, nonsteroidal antiinflammatory agents, radiation therapy, and in some cases, surgical resection. The appropriate timing of surgical resection has traditionally been based on maturity of the HO. The case presented is that of a 33-year-old male with T8 complete paraplegia who developed HO about the left hip resulting in impaired sitting. The patient underwent successful surgical wedge resection of the HO despite apparent immaturity of the HO. A comprehensive review of the literature is presented which suggests that early resection of immature HO may not be predictive of a higher recurrence rate.

The efficacy of nursing education as an intervention in the treatment of recurrent urinary tract infections in individuals with spinal cord injury.

Urinary tract infection (UTI) continues to be the most frequent secondary medical complication experienced by persons with spinal cord injury (SCI). We developed a carepath designed to minimize recurrent UTIs in patients identified as at risk. Data were collected in a prospective fashion for 1,000 consecutive days at an outpatient SCI clinic. The number of UTIs decreased to below threshold in 65 percent of the patients when the nurse clinician counseled them regarding proper technique and hygiene related to clean intermittent catheterization. Of the patients who responded to this intervention, 73 percent required multiple counseling sessions. We conclude that educational intervention by a clinic nurse is a simple, cost-effective means of decreasing the risk of UTIs in individuals with SCI who are identified as at risk.

Neurofibromatosis: an unusual cause of cervical myopathy.

Generalized neurofibromatosis (NF) is characterized by café au lait spots, deformity of the skeleton and tumors involving the skin as well as spinal, peripheral and cranial nerves. The spine is that part of the skeleton most commonly affected in NF, although involvement of the cervical spine in NF has only rarely been reported. The majority of neurofibromas involving spinal nerves are asymptomatic or present with symptoms consistent with nerve root involvement. Classic symptoms of myelopathy secondary to spinal cord compression in NF are rare. We describe a 35-year-old male with generalized NF who presented with worsening gait instability. Magnetic resonance imaging (MRI) revealed enhancing masses producing spinal cord compression at the C1-C2 and C4 levels. The patient underwent decompressive laminectomy and, at eight weeks after surgery, was once again ambulatory. The literature discussing the sequelae and treatment of NF when it produces myelopathy is reviewed.

Outcome after spontaneous spinal epidural hematoma in children: case report and review of the literature.

OBJECTIVE: Spontaneous spinal epidural hematoma (SSEH) is an idiopathic accumulation of blood in the vertebral epidural space without identifiable predisposing factors. First reported in 1869, the clinical outcome in children younger than 18 years old has not been clearly delineated. DESIGN: A comprehensive review of the English language literature revealed 26 patients younger than 18 years old with reported clinical outcomes. The 27th case is presented. RESULTS: Complete neurologic recovery occurred in 14 of 27 (52%) patients, partial recovery in 12 of 27 (44%) patients, and death in 1 of 27 (4%) patients. CONCLUSION: There is an overall good prognosis for neurologic recovery in children who experience SSEH.

Mucinous adenocarcinoma arising from a suprapubic cystostomy site without bladder involvement.

Carcinoma arising from a suprapubic cystostomy site in patients with spinal cord injury has been infrequently described. In all previously reported cases, they have been squamous cell carcinomas. Our patient is a 68 year old male with T10 complete thoracic paraplegia who presented with an exophytic mass extending from his suprapubic cystostomy tract. Biopsy revealed mucinous adenocarcinoma. Carcinoma of the suprapubic cystostomy tract should be considered in those patients who present with bloody drainage and/or masses arising from the suprapubic cystostomy site.

T-cell lymphocytic lymphoma involving the prostate presenting as elevated PSA in paraplegia: case report.

The vast majority of cancers that involve the prostate are adenocarcinomas of the duct-acinar secretory epithelium. Other cancers, primarily leukemia and lymphoma, can involve the prostate and lead to an abnormal digital examination or elevated serum prostate specific antigen (PSA). The case discussed is that of a 62 year-old male with T12 complete paraplegia who presented with a persistently elevated PSA and was subsequently diagnosed with T-cell lymphoma involving the prostate. Although rare, leukemia and lymphoma involving the prostate should be included in the differential diagnosis of patients being evaluated for adenocarcinoma of the prostate.